Anatomical Reduction Research Articles

Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: an anatomical–morphological study

ObjectiveTo digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to develop anatomical plates that align with the characteristics of the pelvis in the Chinese population.MethodsPelvic computed tomography (CT) data from 102 adult patients were collected at the Affiliated Hospital of Zunyi Medical University. This group included 51 males and 51 females, aged between 20 and 60 years. Using Mimics software (version 21.0), a three-dimensional model of each pelvic data point was reconstructed. The fixation path for the combined reset anatomical steel plate was drawn, where the curves on the fixation path were approximated as arcs. The radius of curvature and length of these curves were measured, and an anatomical steel plate was designed to best fit the pelvic structure.ResultsThe combined anatomical reduction plate fixation system for quadrilateral acetabular fractures using a posterior approach consisted of two parts: a locking plate and a reduction plate. The posterior wall region (r2), ischial region (r3), quadrilateral region (r4), and bending region (r5), and the total length of the reduction plate were significantly smaller in females (P < 0.05). Similarly, the posterior wall region (R3), distal posterior wall region (R4), and the total length of the locking plate were significantly smaller in females (P < 0.05). Additionally, the anterior superior iliac spine side (r1) and the total length of the T-shaped auxiliary plate were significantly smaller in females (P < 0.05). The bending angle (< A) was also significantly smaller in females (P < 0.05).ConclusionsThe pelvic surface structure is irregular and varies greatly among individuals.Compared to the traditional steel plate, The combined reduction anatomical plate designed in this study demonstrated high precision and improved conformity to the anatomical structure of the pelvis.

Manual Reduction for Subacute Osteoporotic Burst and Severe Compression Thoracolumbar Fractures

The objective of this study was to retrospectively assess the impact of manual reduction (MR) on patients with subacute osteoporotic thoracolumbar burst fractures and severe compression fractures (OTLBFSCFs). From January 2016 to May 2020, 101 cases of OTLBFSCFs were reviewed, comprising 73 women and 28 men, with an average age of 77.4 ± 8.5 years. Preoperative radiographs, CT or MRI scans, intraoperative C-arm fluoroscopic images, and postoperative X-ray films were utilized to evaluate spinal radiographic parameters. Initially, all patients underwent 3 min of prone positioning as posture reduction (PR), followed by 1–3 sessions of six-member MR to approximate anatomical reduction of the fracture. The average preoperative anterior body height ratio (ABH%) and lateral Cobb angle (LCA) were 38.8% ± 6.2% and 22.6° ± 4.2°, respectively. Post-PR, the average ABH% and LCA were 50.5% ± 8.0% and 14.7° ± 2.7°, respectively. Following MR, the average ABH% and LCA were 99.6% ± 2.4% and 0.4° ± 2.4°, respectively. PR achieved an ABH% correction of 11.7%, while MR achieved 49.1%. LCA restoration was 7.9° with PR and 14.3° with MR. It was deduced that MR proved to be safe and efficacious for subacute OTLBFSCFs and could potentially alter the approach to subsequent surgeries.

Comparison between anterior-to-posterior screw fixation versus posterolateral approach plate fixation for posterior malleous fracture: A systematic review and meta-analysis

PurposeThere are two main surgical fixation methods for the posterior malleolar fractures (PMFs), the anterior-to-posterior (AP) screws or via the posterolateral (PL) approach utilizing a buttress plate. This review aims to compare the clinical outcome between the AP screw fixation and the PL plate fixation for treating PMFs. MethodsWe searched all relevant publications about PMFs treated with AP screws or PL plates through electronic databases including the PubMed, the Cochrane Library, the Embase, the Wiley online library and the Web of Science. The meta-analysis was conducted to evaluated clinical outcomes including reduction quality, post-operative function and complications. ResultsSix studies (one single randomized controlled trial and five retrospective cohort studies) were enrolled. 172 patients underwent AP screw fixation and 214 patients underwent PL plate fixation with a total of 386 patients (169 males and 217 females). The PL plating group yielded better AOFAS scores(MD = 6.97, 95 % CI=[4.68, 9.27], P＜0.00001, I2 =0 %) and was more likely to achieve excellent anatomical reduction(OR=5.49, 95 % CI=[1.06, 28.42], P = 0.04, I2 =80 %). No differences were found in the bad reduction quality, incidences of complications (arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. ConclusionWe suggest that the PL plate fixation method has the clinical benefit of achieving anatomical reduction and better AOFAS scores over the AP screw fixation for treating PMFs. No differences were found in the incidences of complications ( arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. The posterior approach and the direct reduction are recommended for the treatment of the PMFs. Level of ConfidenceⅡb

Minimally invasive fixation of posterior malleolus fracture: description of surgical technique and radiological results

Introduction. Ankle fractures are one of the most common lower extremity injuries. Despite the high incidence of these fractures in the population, the best therapeutic approach has not been established yet. The treatment of posterior malleolus fractures is particularly controversial. Aim. Evaluation of percutaneous posterior-to-anterior fixation of posterior malleolus fracture (posterolateral fragment) in terms of safety of the method and accuracy of fracture reduction. A detailed description of the surgical technique was also presented. Materials and methods. A retrospective evaluation included 18 patients operated on due to complex ankle fractures between April 2023 and March 2024. All patients included in the study underwent percutaneous posterior-to-anterior fixation of posterior malleolus fracture. Patients were evaluated for neurovascular complications and postoperative CT scans were assessed to determine the accuracy of posterior malleolus reduction. Results. In 14 patients (77.8%), the fracture displacement was less than 1 mm; in 3 patients (16.7%), the displacement was 1-2 mm; and in one patient (5.5%), the displacement was &gt;2 mm. No neurovascular complications were observed in any patient. Conclusions. Percutaneous posterior-to-anterior fixation of fractures of the posterolateral part of the posterior malleolus is a safe method and provides a high percentage of anatomical reduction.

Acetabular fractures in geriatric patients: epidemiology, pathomechanism, classification and treatment options.

The incidence of geriatric acetabular fractures has shown a sharp increase in the last decades. The majority of patients are male, which is different to other osteoporotic fractures. The typical pathomechanism generally differs from acetabular fractures in young patients regarding both the direction and the amount of force transmission to the acetabulum via the femoral head. Geriatric fractures very frequently involve anterior structures of the acetabulum, while the posterior wall is less frequently involved. The anterior column and posterior hemitransverse (ACPHT) fracture is the most common fracture type. Superomedial dome impactions (gull sign) are a frequent feature in geriatric acetabular fractures as well. Treatment options include nonoperative treatment, internal fixation and arthoplasty. Nonoperative treatment includes rapid mobilisation and full weighbearing under analgesia and is advisable in non- or minimally displaced fractures without subluxation of the hip joint and without positive gull sign. Open reduction and internal fixation of geriatric acetabular fractures leads to good or excellent results, if anatomic reduction is achieved intraoperatively and loss of reduction does not occur postoperatively. Primary arthroplasty of geriatric acetabular fractures is a treatment option, which does not require anatomic reduction, allows for immediate postoperative full weightbearing and obviates several complications, which are associated with internal fixation. The major issue is the fixation of the acetabular cup in the fractured bone. Primary cups, reinforcement rings or a combination of arthroplasty and internal fixation may be applied depending on the acetabular fracture type.

Our Experience with Primary Trapeziometacarpal Implant Arthroplasty in Severely Comminuted Rolando Fractures

Abstract Background The concept of primary joint replacement in severely comminuted fractures in elderly patients has proven to be a suitable treatment option in the shoulder, elbow and knee joint. Comminuted intra-articular fractures of the first metacarpal base can pose significant technical challenges, and no established gold standard treatment currently exists. Conventional methods like open reduction and internal fixation or external fixation are commonly employed, emphasizing the importance of anatomical reduction for restoring the articular surface. However, achieving articular surface congruity is often unattainable in severely comminuted intra-articular fractures, leading to short-term joint stiffness and instability, as well as long-term complications like secondary osteoarthritis. Aims This case report aims to share our experience with the use of primary trapeziometacarpal implant arthroplasty in the treatment of two patients with severely comminuted Rolando fractures. Methods In two cases of comminuted Rolando fractures, a primary trapeziometacarpal prosthesis (MAÏA™) was implanted based on preoperative decision-making facilitated by 3D-CT analysis. Patient’s visual analogue score for pain, range of motion, pinch and grip strength compared to the contralateral side were asked and examined. Results Both patients exhibited successful adaptation to their daily routines within a three-month postoperative period. No complications, such as cup or stem loosening or dislocation, were identified. Both patients almost reached equal range of motion, pinch and grip strength compared to the contralateral side. Conclusion The use of primary trapeziometacarpal implant arthroplasty seems to be a viable alternative for managing severely comminuted Rolando fractures, particularly in elderly patients and those with pre-existing osteoarthritis. This approach offers promising outcomes. Studies with other implant arthroplasties have shown better outcomes in patients treated primarily, than after several failed surgeries. We suggest the same is true for the trapeziometacarpal joint. Further studies are necessary to validate the efficacy of this intervention in a larger cohort of patients.

Management of Atypical M-Shaped Zygomatic Arch Fractures.

M-shaped zygomatic arch fractures can usually be treated effectively through closed reduction. It consists of 2 fracture segments: the anterior zygomatic segment and the posterior temporal bone segment. In clinical practice, atypical M-shaped fractures are often encountered, in which the anterior and posterior fracture segments are discontinuous and separated. Closed reduction usually cannot achieve the desired anatomic reduction effect for this type of fracture. The preoperative design showed that the anatomic reduction of the posterior zygomatic arch fracture segment was hindered due to bone spurs in the most concave area of the anterior zygomatic bone fracture segment. Open reduction and fixation were performed to achieve anatomic reduction and restore facial symmetry. The fracture sites were exposed through a hemicoronal incision. After the bone spurs are removed, the posterior bone segment can be anatomically reduced. Absorbable plates were used for fixation. The patient's facial appearance was restored after the surgery. The postoperative computed tomography scan showed a good alignment of the fracture. The authors believe that for patients with high requirements for facial symmetry, the presence of atypical M-shaped fractures can indicate open reduction and fixation.

Treatment of Complex Central Talar Fractures with Lateral Plate Combination with Medial Screw Fixation.

The treatment of talar neck and/or body fractures is known to be difficult and challenging, with significant impact on the long-term functional outcome for the patient. The optimal management, including the choice of surgical approaches and implants, are still under constant discussion. The purpose of the study was to investigate the clinical effects of lateral mini-plate combined with medial lag screws for the treatment of complicated central talar fractures. The data of eight patients with complex central talus fractures treated between June 2019 and January 2021 were retrospectively analyzed. There were six males and two females, ranging in age from 15 to 66 years, with an average age of 37.4 years. There were three cases on the left and five cases on the right. All fractures were comminuted, including talar neck with talar body fracture in seven cases and talar body comminuted with subluxation of subtalar joint in one case. All patients were treated with the anteromedial combined anterolateral approach, lateral talar mini-plate fixation and medial lag screw fixation. Fracture reduction quality, union time, and complications were recorded, and functional outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) scoring system. The time from injury to surgery was 1-6 days, with an average of 3.38 days. The follow-up period was 34-53 months (mean 44.88 months). All fractures healed with a mean healing time of 16.75 weeks (13-23 weeks). Anatomical reduction was observed in six cases and near in two cases. After operation, there was no loosening or breakage of implant, loss of fracture reduction, and irritation of skin and soft tissue by internal fixation. The average AOFAS score was 87.38 (48-100), with excellent five cases, good two cases and poor one case, and the excellent and good rate was 87.5%. Superficial skin necrosis in one surgical incision healed after dressing exchange. No deep infection occurred. One case (1/8, 12.5%) developed avascular necrosis of the talus without collapse. Posttraumatic arthritis was found in four cases (4/8, 50%). The utilization of lateral mini-plates in combination with medial screws for treating complex central talar fractures results in satisfactory reduction and stable fixation, mitigating complications associated with poor reduction. However, due to the absence of an anatomical mini-plate, pre-contouring is necessary when applying the lateral plate. This demands a surgeon's thorough familiarity with the anatomical morphology of the talus and proficiency in surgical techniques. Posttraumatic arthritis is the most common complication of complex central talar fractures.

Modified one third tubular plate (spring plate) augmented with reconstruction plates for treatment of comminuted posterior wall acetabular fractures, Short to midterm outcomes of 24 patients.

To evaluate the clinical and functional outcomes of employing a spring plate augmented by a traditional 3.5 mm reconstruction plate for the treatment of comminuted posterior wall acetabular fractures. A prospective case series was performed on 24 patients with comminuted fractures of the posterior wall. After an average of 6 days, the patients underwent surgery. Eighteen patients were fixed with one spring plate, six patients were fixed with two spring plates, and all were reinforced with a 3.5-mm reconstruction plate. Each case was followed once every three months until the fracture healed and then regularly every six months thereafter. There were 21 men and 3 women. The average follow-up period was 14 months, and the median age was 34.5 years. The main reason for injuries was motor vehicle collisions. The mean operation time was 107.5 min. The clinical results were evaluated by the MAP and m HHS, and the means were 10.2 (5-12) and 86 (64-96), respectively. Only two patients developed avascular necrosis and were treated by total hip replacement, another three (12.5%) had mild arthritis. Comminuted acetabulum posterior wall fractures can be stabilized with spring plates. It could be used in conjunction with the primary reconstruction plate as a viable alternative for stable and anatomical reduction. High patient satisfaction and good functional results make this approach effective.

The use of intramedullary reduction techniques in the treatment of irreducible intertrochanteric femoral fractures with negative medial cortical support.

To explore the clinical efficacy of intramedullary reduction techniques for irreducible intertrochanteric femoral fractures with negative medial cortical support. A retrospective analysis was conducted on 69 patients with irreducible intertrochanteric femoral fractures with negative medial cortical support treated in the Department of Orthopedics at Jiangsu Province Hospital (The First Affiliated Hospital of Nanjing Medical University) from July 2019 to December 2021. Patients were divided into Group A and Group B. Group A (experimental group) consisted of 36 cases with an average age of 76.2 ± 5.9 years, while Group B (control group) comprised 33 cases with an average age of 76.6 ± 6.3 years. Group A received treatment using intramedullary reduction techniques, while Group B received treatment using traditional extramedullary reduction techniques. Both groups achieved anatomic reduction of the medial cortex or slight positive support. Surgical duration, intraoperative fracture reduction time, intraoperative bleeding, intraoperative fluoroscopy time, fracture reduction quality, fracture healing, postoperative neck-shaft angle loss, femoral neck shortening, and hip joint functional recovery score (FRS) were compared between the two groups. All patients were followed up for an average of 13.8 months. Group A showed superior outcomes compared to Group B in surgical duration, intraoperative fracture reduction time, intraoperative bleeding, intraoperative fluoroscopy time, fracture reduction quality, fracture healing, postoperative neck-shaft angle loss, and femoral neck shortening (P < 0.05). Hip joint function assessed by functional recovery score was better in Group A than Group B at 1 and 3 months postoperatively (P < 0.05), with no significant statistical difference at other time points (P > 0.05). For irreducible intertrochanteric femoral fractures with negative medial cortical support, intramedullary reduction techniques used during surgery demonstrated simplicity, significant reduction in surgical duration, decreased intraoperative bleeding, fewer amounts of intraoperative fluoroscopy, improved fracture reduction quality, and reduced surgical complexity. Further clinical research and application are warranted.

SURGICAL OUTCOMES IN INTRAMEDULLARY FIBULAR NAIL FIXATION COMPARED WITH PLATE FIXATION OF DISTAL FIBULAR FRACTURES

IntroductionThe condition of the soft tissues surrounding an ankle fracture influences timing and treatment of injuries. Conventional treatment used an open approach to facilitate anatomical reduction and rigid internal fixation. Intramedullary devices for fibular fractures provide a safe alternative in patients in which the condition of the soft tissue envelope or the patient's co-morbidities may benefit from a less invasive approach. We compared outcomes for patients treated with open reduction internal fixation (ORIF) with those undergoing treatment with fibular nails (FN)Methods13 consecutive patients treated with fibular nails (FN) were compared with 13 age-matched patients that underwent open reduction and internal fixation (ORIF). All patients were followed to union. Study outcomes were time from admission to surgery, length of stay, wound failure, implant failure, revision surgery, OMAS and SF-36ResultsThere was no difference in age or sex distribution between groups. There was no difference in OMAS at 1 year (83 ± 9 in FN group; 80± 21 in ORIF group) and SF-36 (94 ± 11 and 90 ± 20). There were 2 implant failures in the ORIF group and none in the FN group. There was one wound failure in the ORIF group and none in the FN group. Patients treated with FN had a shorter time to surgery (1 day ± 24 hours vs 3 days ± 24 hours) and shorter length of stay (1 day ± 24 hours vs 4 days ± 96 hours)ConclusionFN is a safe method to treat patients with displaced distal fibular fractures that may have a poor soft tissue envelope and risk factors for wound healing. FN reduces the time to surgery and overall length of stay compared with similar patients treated with conventional ORIF.

THE ARTHROSCOPIC MANAGEMENT OF TALAR BODY FRACTURES

Talar body fractures are high energy intraarticular injuries that are best management by anatomical reduction and secure fixation to improve outcomes. The talus is relatively inaccessible surgically and requires extensive soft tissue dissection and/or osteotomies to gain adequate open visualisation. There are a small number of case reports on arthroscopic assisted fixation in the literature. This case series reports on the technique and early outcomes of six patients all of whom presented with significant intraarticular displacement and who were managed entirely arthroscopically.The fractures were of the main body of the talus involving the ankle and subtalar joints and all had preoperative CT scans. All six patients underwent posterior ankle and subtalar arthroscopy with cannulated screws used to stabilise the fractures after reduction. Visualisation of the fracture reduction was excellent. After 10 days in a backslab, the patients were protected in a boot and encouraged to actively move their ankles. Weight bearing was permitted once union appeared complete.There were no early complications of infection, avascular necrosis or VTE. There was one patient that had a non-clinically significant migration of a screw. Two patients were lost to follow up early due to being visitors. The mean length of follow up was 12 months in the remainder. The remaining four patients all returned to their preoperative level of activity. All had demonstrable subtalar stiffness. There was no early post-traumatic arthritis.This series represents the largest so far published. The main flaw in this report is the lack of long term follow up. While this report cannot state superiority over open techniques it is a safe, effective and acceptable technique that has significant conceptual benefits.

Open Dislocated Interphalangeal Fracture of the Thumb in a 16-Year-Old Basketball Player

Phalangeal dislocation fractures of the hand are common in the sports world especially contact sports and ball sports. Open ones are less common. In this article we report a case of a 16-year-old young basketball player who injured her right thumb during a practice. Clinical and radiological examinations showed an open phalangeal dislocation fracture of the thumb. Management consisted of immediate reduction, abundant washing and finger splint for 4 weeks after X-rays showed anatomical reduction. Short, medium and long term clinical and radiological examinations showed good evolution. At our last follow up (1.5 years) our patient had regained full use of her hand in both daily and sporting activities. The purpose of this study is to encourage non operative treatment in dislocated fractured fingers when treated early if the initial external reduction is anatomical, and to show the need for further studies in similar cases in the sport world.

Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture.

According to Vancouver classification, B2 type fractures are most often treated with removal of the loose stem and implantation of a long stem that bypasses the fracture site. However, there is a controversy about the stem fixation that should be used: cemented or cementless. Hence, this study aims to compare cemented and cementless stems in prosthetic revision due to Vancouver B2 (VB2) periprosthetic hip fracture. A retrospective study was done including all the patients treated with stem exchange due to VB2 periprosthetic hip fracture in a tertiary hospital between 2015 and 2022. Patients were divided into two groups according to the stem fixation used: cemented or cementless. Functional outcomes, hospital stay, surgical time, complication rate, and mortality were compared between the two groups of patients. Of the 30 included patients, 13 (43.4%) were treated with cementless stems and 17 (56.7%) with cemented stems. There were no statistically significant differences in age, gender, anesthesia risk scale (ASA) or functional capacity prior to the intervention. Patients treated with cementless stems had a higher complication and reintervention rate than those treated with cemented stems: 62 and 45% versus 34 and 6% (p = 0.035; p = 0.010), respectively. Furthermore, in the group of cementless stems a higher proportion of non-union was found (53.8% vs. 17.6%; p = 0.037). Also, the hospital stay (33 vs. 24days; p = 0.037) and the time to full weight-bearing (21days vs. 9days; p < 0.001) were longer in the cementless stem group. Cemented fixation in stem revision due to Vancouver B2 periprosthetic hip fracture could be an optimal option with faster recovery which could decrease the rate of complications and reintervention, without compromising the fracture healing and patient mortality. Thus, this option can be considered when an anatomical reduction can be obtained, especially in elderly patients with multiple comorbidities in which a less aggressive surgical option should be considered.

Mechanical effect of changed femoral neck ante-version angles on the stability of an intertrochanteric fracture fixed with PFNA: A finite element analysis

ObjectiveChange of femoral neck ante-version angle postoperatively due to inadequate reduction could result in unsatisfying treatment outcome of intertrochanteric fracture. However, the influence of increased or decreased femoral neck ante-version on the biomechanical stability of the bone-implant complex has rarely been studied. MethodsA finite element model of a complete normal human femur with normal femoral neck ante-version as 13° was established accurately by scanning a 64 year old female femur. The models of 31-A1.1 intertrochanteric fractures with different femoral neck ante-version angles of 3°, 5.5°, 8°, 10.5°, 13°, 15.5°, 18°, 20.5°, 23° were created. They were assembled with a proximal femoral nail anti-rotation (PFNA) device. The biomechanical differences with varying femoral neck ante-version angles were compared using finite element analysis method. ResultsAs the femoral neck ante-version angle gradually increased from 13° to 23°with a gradient of 2.5°, the peak von Mises stress was gradually increased from 137.82 MPa to 276.02 MPa. Similarly, the peak von Mises stress was gradually increased from 137.82 MPa to 360.12 MPa with the femoral neck ante-version angle decreased from 13° to 3°. When decreased ante-version angle of 7.5° and increased ante-version angle of 10° will exceed the yield strength of femoral (240.32 MPa), the risk of femoral fracture will increase significantly. The maximum displacement of the femur was significantly reduced for increased ante-version models than for decreased ante-version models, whether the changes of ante-version angles were 2.5°, 5°, 7.5° or 10°. The maximum stress of PFNA was found in the intersection of main nail and helical blade, and became greater gradually as the ante-version angle increased or decreased with a gradient of 2.5°. The maximum stress of PFNA was presented in the model 5.5° with the maximum stress of 724.42 MPa (near to the yield strength of titanium alloy of 700–1000 MPa), producing the breakage risk of PFNA. The maximum displacement of the PFNA was significantly reduced for increased ante-version models than for decreased ante-version models, whether the changes of ante-version angles were 2.5°, 5°, 7.5° or 10°. ConclusionBased on the results of present study, it was demonstrated that the anatomical reduction of femoral neck ante-version was vital to secure the optimal stability. Abnormal femoral ante-version could increase the potential risk of failure for intertrochanteric fracture after PFNA. The stability of increased femoral ante-version (less than 10°) was superior to the stability of decreased ante-version (less than 5°) for the cases of difficulty to acquire anatomical reduction. The clinical implication of the finding was that increased femoral neck ante-version had an advantage of mechanical stability towards the decreased femoral neck ante-version for the cases of comminuted intertrochanteric fracture and failure of anatomical reduction.

Double Row Rotator Cuff Repair for Massive Reparable Rotator Cuff Tear

Background: Massive rotator cuff tears, defined as those that involved 2 or more tendons or where the length of the greatest diameter is greater than 5 cm, present a unique surgical challenge as there can be significant scarring, retraction, and poor tissue quality. Furthermore, healing of these tears is less reliable. This video presents our technique for anatomic, double row repair of a massive reparable rotator cuff tear. Indications: Indications for operative intervention include acute traumatic tears, as well as patients with pain and weakness who have failed to respond to conservative management, including physical therapy with confirmed large full thickness rotator cuff tear on advanced imaging. Of note, findings such as glenohumeral osteoarthritis, advanced muscle atrophy (Goutalier III/IV), superior migration of the humeral head &gt;7 mm, and tears larger than 40 mm in length and width are concerning for irreparable tears, and may represent contraindications to surgical repair. Technique Description: The patient is placed in the lateral decubitus position. After diagnostic arthroscopy is performed, a subacromial bursectomy is performed. A radiofrequency probe and arthroscopic shaver are used to perform releases in the subacromial space as well as superior to the glenoid. Preparation of the footprint of the humeral head is then performed to create a good healing surface. The rotator cuff is grasped to confirm tension free mobilization. The medial row anchors are then placed. Once placed, the sutures are incorporated into 2 lateral row anchors in sequential fashion. Subacromial decompression is then performed. Results: Reduced pain and improved shoulder function are the goals of treatment, with sling immobilization lasting for roughly 6 weeks postoperatively prior to initiating strengthening and range of motion protocols. Discussion/Conclusion: Arthroscopic double row repair produces an anatomic and stable reduction of reparable massive rotator cuff tears for patients that have failed conservative management. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Surgical management of supracondylar femur fracture using rush pinning technique in dogs

Surgical management of supracondylar femur fracture using rush pinning technique in dogs

Use of a novel three-dimensional anatomical plating system for treatment of caudal mandibular fractures in cats: 13 cases (2019-2023).

A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed. Preoperative, immediate postoperative and a minimum of 8 weeks postoperative CT images were required as inclusion criteria. The outcome and complications were determined from clinical data and radiographic follow-up examinations. All cases achieved adequate anatomical reduction, resulting in a functional and atraumatic occlusion postoperatively. No intraoperative complications were reported. Time to voluntary food intake was in the range of 1-25 days. No evidence of disruptions to the implants or screw loosening was observed in the 8-week postoperative CT imaging, with radiographic evidence of complete osseous union in all fractures. The most common postoperative complication was swelling at the surgical site. Two cats had postoperative exophthalmos due to retrobulbar haemorrhage, and one cat exhibited partial wound dehiscence 5 days postoperatively, which resolved with medical management. Longer-term complications included intraoral plate exposure in one cat, which required plate removal 10 months postoperatively. In this case series, rigid internal fixation of caudal mandibular fractures using the Ramus Anatomical Plate osteosynthesis system was associated with a minimal complication rate, and satisfactory radiographic and clinical outcomes. The reported outcomes of this novel technique are favourable when compared with previous techniques described for the management of these fracture types.

Study on the Results of Laminectomy with Short Segment Pedicle Screw Fixation in Dorsolumbar Fractures with Respect to Anatomical Reduction, Functional Recovery, and Pain

Abstract Background: This study aimed to report the results of laminectomy with short-segment pedicle screw fixation in thoracolumbar fracture. Materials and Methods: Forty-two patients were analyzed prospectively, and followed up in the outpatient department for 24 months. Results: The results revealed that most of the patients in the study had reasonable to good neurological recovery in the postoperative period assessed in the form of an American spinal injury association impairment scale (ASIA) score. There was also an excellent improvement in the components of anatomical reduction like vertebral height, Cobb’s angle, and anterior wedge angle, which was directly related to the functional recovery of the patient. Postoperatively, the patients also got relief in pain in the dorsolumbar region assessed based on the Denis pain scale. Conclusion: This study concludes that laminectomy with pedicle screw fixation is an excellent option for patients with thoracolumbar fracture, it not only decompresses the spine but also provides stability with minimal manageable complications.

Evaluation of optimizing Monteggia fracture-dislocation care: surgical innovations, radiological insights, and functional rehabilitation in adult patients

Background: Monteggia fractures, rare in adults, involve proximal ulna fracture and radial head dislocation. Managing these injuries poses challenges, fueling historical debates and driving advancements in internal fixation. Watson Jones' frustration highlights the ongoing pursuit of effective surgical approaches for optimal outcomes and functional limb restoration. his study aims to evaluate Monteggia fracture-dislocation treatment by analyzing radiological outcomes for structural insights and alignment post-surgery. Methods: This prospective observational study, conducted at Swapno general hospital, Mirpur-2, Dhaka, Bangladesh from 1st January 2021 to 31 January 2024, enrolled 30 patients with radiologically confirmed Monteggia fracture-dislocation. Surgical procedures involved creating an interval, anatomical reduction, and fixation, with regular follow-ups assessing outcomes, including range of motion, X-rays, and VAS scores, while statistical analysis utilized SPSS version 23. Results: The highest frequency percentage in the age distribution was observed among individuals aged 41-45, constituting 20% of the total sample, while the lowest frequencies were recorded in the 31-35 and &gt;51 age groups, each representing 10% of the sample. Physical assault emerged as the leading cause of injury, accounting for 40% of cases, followed by road traffic accidents at 36.66% and falls at 23.33%. In terms of final outcomes, the majority of patients (43.33%) achieved a good outcome, while the lowest percentage (10%) resulted in poor outcomes. Conclusions: In conclusion, addressing Monteggia fracture-dislocation in adults requires navigating inherent complexities. Modern internal fixation methods prove impactful, emphasizing the need for precise classification and stable anatomical reduction.